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NPI Code Detail

MEDICARE: CYNTHIA GRAHAM MSSW LCSW

MEDICARE: CYNTHIA GRAHAM MSSW LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker34002335AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5839090IIOTHERINMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000295773OTHERINANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3800006280OTHERINRAILROAD
411490663OTHERINCAQH

General Provider Information

NPI Number : 1578574562
Entity Type Code : Individual
Provider Name (Legal Business Name) : CYNTHIA GRAHAM MSSW LCSW
Provider Business Mailing Address
First Line : 6211 WATERFORD BLVD
Second Line :
City : EVANSVILLE
State : IN
Zip : 47715-2869
Country : US
Telephone Number : 812-465-6202
Fax Number :
Provider Business Practice Location Address
First Line : 6211 WATERFORD BLVD
Second Line :
City : EVANSVILLE
State : IN
Zip : 47715-2869
Country : US
Telephone Number : 812-465-6202
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 10/27/2018

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